Attention deficit hyperactivity disorder: special education policy and practice in Australia.

With growing numbers of Australian children receiving Attention Deficit Hyperactivity Disorder (ADHD) diagnosis, special educators will increasingly be expected to provide interventions. We outline Australian special education policy and practice regarding ADHD in the public school context. Drawing upon American comparisons, we consider how recent government legislation may have made the label `disability' appear pragmatic to those seeking special education assistance, and discuss whether making ADHD an educational disability category would expand the range of interventions currently available. Although biological aspects of ADHD have received much attention, the important social aspects remain relatively unexplored. We propose that a socially sensitive reconceptualisation will assist special educators to better meet the needs of young people with impulsive, inattentive and hyperactive behaviours.

Introduction

Attention Deficit Hyperactivity Disorder (ADHD) is defined by the Australian National Health and Medical Research Council (NH&MRC) (1997) as a syndrome resulting in hyperactive, impulsive and inattentive behaviours that cause social impairment in home, school and work settings. ADHD is considered a medical/psychiatric disorder; however, this runs the risk of oversimplifying a complex phenomenon. ADHD cannot be adequately viewed from a unitary perspective, because ADHD is a disorder that crosses many different domains. It is unrealistic to expect one overarching construct--no matter how broad--to have sufficient explanatory power (Whalen & Henker, 1996). For example, in addition to the medical perspective, psychological approaches must be acknowledged. Problems such as depression, anxiety, cognitive distortions, temperament, motivation, and even giftedness can produce ADHD-like behaviours (British Psychological Society (BPS), 1996; Maag & Reid, 1994; Tally-Ongan, 1997).

ADHD is now one of the most commonly diagnosed disorders among Australian and United States children (Gadow, 1993; Prosser & Reid, 1999; Valentine, Zubrick, & Sly, 1996), and the rate of ADHD diagnoses has been increasing. Some suggest this reflects increased awareness of and necessary treatment for a medical condition. Others link increasing diagnosis to special education policy. For example, Diller (1998) argued that the United States (US) increase in ADHD was a result of the Education Department's clarification of services available to diagnosed students. The former view represents the `reductionist' or medical perspective that regards ADHD as a biological phenomenon. The latter `sociological' perspective views ADHD as a phenomenon within a social and cultural nexus and permits understandings that are dictated by political and economic factors.

This paper reviews the present and future possibilities for special education interventions for ADHD in Australia. First, we compare the Australian and overseas (especially the American) situations to outline how existing policy shapes ADHD interventions in the public school context. In the second section, we argue that contemporary Australian policy may be the catalyst for the growth in calls for including ADHD as a disability category. We conclude by arguing that an emphasis on the social and educational aspects will enable special educators better to meet the needs of students diagnosed with ADHD.

ADHD and special education policy in United Kingdom, United States, and Australia

Some nations, for example the United Kingdom (UK), favour psychological and educational interventions for inattentive, impulsive and hyperactive behaviours (BPS, 1996). Others, like Australia and the US, are increasingly considering these behaviours as a disability requiring specific medical interventions.

Within the UK, diagnosis is comparatively low, being based on the rigorous International Classification of Disorders (World Health Organisation, 1993) criteria. Furthermore a child does not need a medically assigned disability label to gain access to special education assistance (Cooper & Ideus, 1995). By contrast, American legislation requires that children meet the criteria for specific learning disability categories (BPS, 1996). ADHD is not itself a disability in the US, but 50 per cent of students with ADHD qualify for assistance with comorbid learning disabilities and behavioural disorders (Reid, Maag, Vasa, & Wright, 1994). The needs of the remaining 50 per cent can be met through legislation which ensures that all American young people with barriers to significant life activities are eligible for assistance in school (Reid & Katsiyannis, 1995).

In Australia, the federal Disability Discrimination Act (DDA) refers to categories included within the DSM-IV-TR (American Psychiatric Association, 2000) as disabilities, whereas state legislation varies. For instance in South Australia, the Department of Education, Training and Employment (DETE) policy relies on state equal opportunity legislation, which does not recognise ADHD as a disability. Theoretically the education of South Australian students is based on curriculum needs rather than disability labels, and disability alone does not necessarily determine special education provisions (Department of Education and Children's Services (DECS), 1991). However there is reason to believe that there is a gap between policy and practice in South Australia (Atkinson, Robinson, & Shute, 1997; Prosser, 2000).

Although the situation for students with comorbid learning difficulties is similar to that in the US, significant cracks are appearing between Australian disability discrimination and equal opportunity legislation. This has placed considerable pressure on special educators as increasingly moderate or educational disabilities have been given distinct labels and used as a means to compete for finite and diminishing special education resources.

As Cooper (1994) notes, medical labels such as disability only become educationally significant when they become pragmatic in gaining special education assistance. This is exemplified by Latham and Latham's (1992) advice to US advocates seeking assistance for children with ADHD. Since impairments seen to have environmental, cultural or social causes were not deemed eligible for assistance, they recommended an emphasis on the neurological basis of ADHD.

There is good reason to believe that such a reductionist view has successfully influenced institutional responses. Damico and Augustine (1995) found that an ADHD diagnosis significantly helped parents obtain additional services from schools (e.g. classroom support and concessions in examinations). Further, they found the label was usually sought only after parents became dissatisfied with school responses to their child's difficulties, and was attractive primarily because parents believed it assisted in accessing educational accommodations. Calls for such accommodations in Australia have created a challenge to existing public policy, with one highly publicised refusal for additional time in an examination by the New South Wales Education Department and over 30 applications for special consideration in the Victorian Certificate of Education in 18 months.

United States policy in practice

Two US federal laws concern educational services for children with disabilities. The Vocational and Rehabilitation Act of 1973 (RHA) was civil rights legislation containing a specific passage (Section 504) to terminate federal funding to institutions discriminating against individuals with disabilities. It did not establish categories, but defined disability extremely broadly. A student was considered disabled based on the school's judgement of a physical or mental impairment significantly affecting a major life activity, including learning and behavioural difficulties and poor social skills. The 1975 Education for the Handicapped Act (EHA) (Du Paul & Stoner, 1994) in practice largely subsumed and superseded Section 504. It established federally recognised categories of educational disability, and mandated specific rights, such as individualised educational plans, for children with disabilities. The categories of educational disability were narrowly drawn, and eligibility criteria expressly defined.

Both the EHA and Section 504 include a `child-find' provision, mandating schools to make pro-active efforts to identify and serve all children with disabilities. Moreover both laws require that assessment, accommodation and individualised educational plans be provided at no cost to parents (Latham & Latham, 1992; Macciomei, 1993). Under the EHA, funding was given to schools to ensure provision of Individualised Education Programs, whereas Section 504 did not provide any funding (Reid & Katsiyannis, 1995). Another difference concerned qualification for services. Under the EHA, ADHD was not expressly included as a category of disability, therefore the diagnosis did not guarantee the special education services, which parents sought increasingly from the late 1980s. Children had to qualify under the established categories, which many with ADHD did not meet. Although most would qualify for services under Section 504, many parents and educators were unaware of this (Reid & Katsiyannis, 1995).

Advocacy groups therefore began a concerted effort to have ADHD defined as a disability. In 1990 the EHA underwent a periodic re-enactment process resulting in the 1990 Individuals with Disabilities Education Act (IDEA). Parent and advocacy groups lobbied intensively to include ADHD (Diller, 1998), but were unsuccessful (Macciomei, 1993; Turnbull, 1994). However this pressure resulted in the US Education Department distributing a 1991 memo clarifying how students with ADHD could obtain assistance under the IDEA (Aleman, 1991). Students were eligible if they met the requirements for existing categories (e.g. learning disability), but could also qualify under the `other health impairment' category if attention problems significantly affected their education. Alternatively accommodations could be made under Section 504 of the RHA.

It is from this legislative interplay that confusion over ADHD's status as a category of educational disability originated. To many parents and special educators (unaware of legislative intricacies), it seemed that the ADHD label was an effective means to access additional educational services (Damico & Augustine, 1995; Diller, 1998). However only about half of students with ADHD obtained assistance under the IDEA, resulting in confusion and frustration.

Schools were often reluctant to provide assistance for ADHD. DuPaul and Stoner (1994) explained this as due to a shift within educational institutions towards standardisation, outcome-based assessment and limited resources. Concerns over the educational utility of medical labels saw education providers increasingly emphasise practical interventions for observable difficulties. Special educators were often caught between two compelling arguments, as parents saw ADHD as an educational disability, whereas education departments and schools claimed that the label was neither educationally relevant nor legally recognised.

Because many children failed to qualify under EHA or IDEA, parents and advocates sought alternative access to services, resulting in a resurgence of the long dormant Section 504 (Reid & Katsiyannis, 1995). Thus many students gained access to educational services under Section 504's broader definitions, not because of their ADHD diagnosis (Macciomei, 1993).

Australian policy situation

As in the US, there are no Australian ADHD-specific federal or state policies. Neither is it considered a specific learning disability (NH&MRC, 1997). Whereas the Commonwealth Disability Discrimination Act (DDA) covers categories in the Diagnostic and Statistical Manual of Mental Disorders (APA, 2000) (thus indirectly defining ADHD as a disability), most states use their own equal opportunity legislation (which does not include ADHD as a disability) as the basis of special education policy. Some federal funding assists the states to provide education services, but primarily states must respond to demand from within their annual general education funding (Department of Employment, Education, Training and Youth Affairs, 1997; NH&MRC, 1997).

In short, Australia and America are similar in that approximately 50 per cent of students with ADHD should receive special education assistance under disability legislation. However there is no Australian Section 504 equivalent covering students with significant barriers to life activities. Further the absence of a `child find' clause means that up to 50 per cent of students with ADHD may not be receiving the assistance they require. Some families have sought to gain assistance by proving their child qualifies under the DDA. This process is often prohibitively costly and diametrically opposed to the US situation where schools are required both to locate and assess children with disabilities, at no cost to parents. Not surprisingly parents have increasingly called for state legislation to come in line with the federal DDA (in the process, including ADHD as a disability category) and shift the onus back onto the state governments to provide support through special education policy.

A significant catalyst to these calls has been underlying state and federal funding cuts in public education. Departmental rhetoric claims that all students with educational needs will receive the necessary assistance without a label such as ADHD or disability. In practice, however, funding reductions, along with an increasing range of competing special needs, has seen a rationalisation of resources.

Although policy provides for all students with needs, in practice only those with extreme difficulties or those seen to have legitimate claims within existing policy receive assistance, and often ADHD is not deemed a high priority. In some states, students need to be more than five years behind in their literacy or numeracy, or have had a significant history of expulsion, before they become a priority for limited behaviour management or student disability resources. This poses a dilemma for special educators. They are aware that such delays run counter to best practice that mandates early identification and intervention. They try to allocate limited human and financial resources strategically, but often it is impossible to satisfy competing demands. This has led some advocates to consider the redefinition of ADHD as an educational disability as a means to lobby for scarce resources.

The response by state governments has largely been that students should receive assistance according to educational needs and not labels, hence making ADHD a disability would be irrelevant. However, in a political context of declining education funding and competition between service providers, increasingly only the most urgent needs are being met (Smyth & Hattam, 1998). Further there has been an increasing emphasis on individual deficit in funding criteria (Comber, Green, Lingard, & Luke, 1997; Thomson, 1997). Together these changes resulted in an official shift of greater responsibility for the problem behaviours back onto families, for many of whom the only affordable interventions come through Medicare bulkbilling and cheap listed dexamphetamine on the Pharmaceutical Benefits Scheme (Atkinson, Robinson, & Shute, 1997; Prosser & Reid, 1999).

Given the above situation, it is not surprising that there has been increasing parent, advocate and special education professional pressure for ADHD to be recognised as a disability category in state legislation. At this time, ADHD is not recognised as a learning disability in any Australian state. While the Victorian Department of Education, Employment and Training bases its special education policy on the International Classification of Mental Disorders (WHO, 1993) only students with severe behavioural problems qualify for the severe emotional disorder category and are placed in specialist schools. Students with less severe problems rely on local schools to allocate resources from school global budgets according to perceived need. At this time DEET has not issued guidelines to local Victorian schools in relation to ADHD.

However most departments of education have responded by releasing clarified guidelines similar to those of the US Education Department in 1991. Largely they identify support for students with ADHD within existing services and policy (e.g. guidance officers, federally funded literacy or numeracy programs, and behaviour management units). However responsibility has largely remained with special education practitioners or classroom teachers. For instance, in South Australia, DETE (1999) guidelines explain that individual classroom teachers are largely responsible for building positive relationships, fostering emotional resilience, devising alternate management plans and so forth.

As is the case in most states, these guidelines are based on the argument that, although ADHD is a risk factor, it is not in itself grounds for additional educational assistance or specific policy. However such a position was recently rejected by the Western Australian parliamentary inquiry into ADHD. It found that a significant barrier to the effective treatment of ADHD was that education departments treated ADHD as one of many disorders which may place a child at educational risk, rather than as a separate learning and behaviour category (Standing Committee on Constitutional Affairs, 1999). The Committee's recommendation to develop new policies and guidelines is currently before the Western Australian government.

It would seem that, although the recommendations of most states are sound in theory, they risk falling short of the needs of students. This is because of a lack of adequate consideration of the particular behavioural and learning challenges ADHD presents to teachers in classrooms (Atkinson, Robinson, & Shute, 1997; Reid & Katsiyannis, 1995). Common problems include difficulty in balancing the needs of the ADHD student with those of others in the class, the increasing administrative workload of educators, teachers being largely unaware of how to access services, or teachers not being trained to implement them for students with ADHD. Without additional resources and possibly new policy, it is unlikely that these guidelines will be properly implemented.

One possible exception is New South Wales. While still not resolving the concerns raised by the Western Australian parliamentary inquiry, DET has increased special education resources significantly so that theoretically all children with barriers to learning can receive assistance. This assistance is detailed in the Department's latest guidelines (DET, 1997) and takes the form of the allocation of a Learning Support Team to develop a targeted management plan (including social and behavioural interventions) for every student with learning problems resulting from ADHD.

The mere presence of guidelines does not guarantee implementation, which in the case of ADHD has left a pronounced gap between policy and practice in most if not all states. The risk is that departmental guidelines may become little more than unfunded mandates and will do little to tackle the complex cultural, political and economic contexts facing families seeking assistance. This situation is not unique to Australia. Concerns about a possible gap between service provision theory and practice have also been raised internationally (Bussing, Schoenberg, Rogers, Zima, & Angus, 1998; Damico & Augustine, 1995; Hazell, McDowell, & Walton, 1996), and have become the basis for growing calls for ADHD's inclusion as a disability category.

ADHD as an educational disability category

For many advocates, the inclusion of ADHD as a disability category is the single most useful policy change governments could make. Yet, for many policy makers, this seems little more than a futile gesture that would place more unrealistic expectations on schools. Perhaps the most comprehensive critique of ADHD as a disability category in the US is that by Reid, Maag, and Vasa (1994). They noted that, although teachers and parents face significant struggles, an ADHD diagnosis yields no additional educational interventions, only access to medication and that diagnosis by medical practitioners further questions the label's educational relevance, highlighting a risk that educators may see ADHD as strictly biological and thus outside their expertise. It would be concerning if the inclusion of ADHD as a disability category resulted in a further marginalising of educational interventions.

One powerful argument for ADHD's inclusion as a disability category would be if educational failure commonly occurred. However research has shown that, although ADHD is a pronounced risk factor, it does not presuppose educational failure (Reid, Maag, Vasa, & Wright, 1994). Similarly Barkley (1995, 1998) has shown that, although up to 40 per cent of young people with ADHD have reading, spelling or mathematical disabilities, the majority perform adequately. Barkley described including ADHD as an educational disability category as a largely irrelevant exercise.

Bussing, Zima, Perwein, Belin, and Widawski (1998) also questioned the practical utility of the disability label. They noted that, although half the children in America qualifying for special education were also eligible for an ADHD diagnosis, only half of these actually obtained assistance for ADHD. In fact, learning disability status approximately doubled the odds of a child not receiving the full range of services necessary for ADHD. They argued that the construction of ADHD as a medical condition and disability made paediatricians into gatekeepers to additional educational services and resulted in an emphasis on mental health and stimulant treatment, rather than educational interventions as part of the recommended multi-modal approach (Bussing, Schumann, Belin, Widawski, & Perwein, 1998). In the Australian context, Atkinson and Shute (1999) have similarly reported that the acceptance of ADHD as a medical disorder encourages the belief that non-medical professionals can play, at best, a secondary role in assessment and interventions.

Furthermore Damico and Augustine (1995) observed that one of the associated costs of the label is a medical and individualistic focus, often resulting in greater individual and institutional marginalisation. However, the cultural, economic and political power provided by medical endorsement of certain behaviours must not be underestimated. In certain contexts, it can be the difference between a family accessing support and their child completing school, and that same family being stretched to breaking point. What must be ascertained in each context is whether the inclusion of ADHD as a disability category is the light at the end of the tunnel or, as Diller (1998) implies, an oncoming train.

Diller (1998) further argues that advocates of ADHD as a disability category have failed to consider the state of special education funding in the US. Current demands have nearly exhausted the special education budget, and increasingly schools have been forced to tap into their general budgets. Creating a new disability could literally bankrupt the system, so that special education services would simply not be available irrespective of the label applied. In Diller's view, assistance for ADHD would not improve without change to underlying principles in funding and policy.

Reconceptualising ADHD

Reconceptualising ADHD as both social and biological is an important first step to determining the limitations that face special educators on both the classroom and systemic level. A sociological view of ADHD explores its political, economic and cultural underpinnings, noting that within Australia the facilitation of improved special education interventions has been secondary to medical approaches over the last 20 years. Thus many special educators feel ill-informed about ADHD, and departmental guidelines have largely focused on pragmatic responses to individual needs, given current education policy and funding limitations. Further the lack of human and financial resources continues to limit significantly the ability of special educators to meet the needs of young people with ADHD.

The emphasis within government guidelines on ADHD as a medical issue seriously marginalises the expertise of special educators. It also fails to consider how societal change is reforming the expectations on students and educational institutions. This individual focus also depoliticises ADHD by preventing a consideration of how problems may be exacerbated by systemic resource inadequacies. Finally a medical emphasis risks neglect of the important social barriers to successful educational attainment, particularly as young people with ADHD enter secondary school (Maag & Reid, 1994; Prosser, 2000).

These problems can be redressed by reconceptualising ADHD as multifaceted and encompassing biological, psychological, and social aspects. A sociological understanding of ADHD not only provides a means to explain the rapid growth in ADHD diagnosis over the last decade, but opens up for examination the cultural conditions that have created an unbalanced understanding of the condition in contemporary policy and practice (Ideus, 1994).

Social aspects of ADHD

By definition, the label `disorder' refers as much to non-conformity to social norms as it does to physiological difference. As Wakefield (1992) puts it:

   A disorder exists when a failure of a person's internal mechanism to
   perform impinges on the person's well being as defined by social values and
   meanings. The order that is disturbed is thus simultaneously biological and
   social; neither alone is sufficient to justify the label disorder. (p. 373)

An example of the consideration of the cultural side of labels such as `disorder' can be found in the work of Becker (1963, 1964, 1973). Becker argued that the act of labelling reveals as much about the labellers as the labelled. For example, not staying in one's seat in the classroom becomes a problem because of the cultural preference in most schools for silent and sedentary work. Further this perspective enables one to question cultural, economic or political changes rather than relying solely on notions of individual deficit.

An example of a more philosophical and political consideration of labels can be found in the work of Foucault (1965, 1975, 1977), who explored the subjective influences on so-called `objective' social labels as well as the cultural practices developed to enforce them. For example, the act of labelling a child's activity level `abnormal' fails to acknowledge that we all at times participate in behaviour that could appear abnormal in a different context. Thus a child who is responding in a logical and pragmatic way (given the particular context) could be labelled hyperactive if the observer was not sensitive (to that context).

Examples of the role of political and economic influences on labels can be found in the work of Oliver (1990), Miller and Branson (1989) and Goodson and Dowbiggin (1990). They find that academic disciplines and governments can have an important role in creating, enforcing and maintaining social labels such as disorder and disability through policy and legislation. For example, if the label `disorder' provided additional accommodations for children with overactive behaviours, there would be a marked economic and social incentive for active children to be labelled `disordered'. Diller (1998) succinctly summarised the social side of disorders when he observed that it is unrealistic to expect the human gene pool to change for cultural or economic reasons in the space of 30 short years. Yet the expectation of modern society to `perform or else!' has in fact forced us to do so.

In response, we reaffirm that, although biological or genetic differences are the basis of difference and may play a part in ADHD, it is the impairment associated with social norms that redefines these differences as a disorder. Thus we suggest that it may be unreasonable to consider the individual alone as the problem. It leads one to ask: Might ADHD demonstrate how our society and institutions are failing our young people rather than how our young people are failing our society and institutions?

Summary

When the needs of children with hyperactive, inattentive and impulsive behaviours and their families are being met, labels such as ADHD are of little relevance. However, when these behaviours create unmet needs, medically endorsed labels become important lobbying tools.

Until recently, the response of Australian state governments has been to claim that the needs of young people with these behaviours are being met, and the only additional assistance an ADHD diagnosis provides is medication. One would then expect, with adequate service delivery, that ADHD diagnosis and medication use would have grown slowly and gradually as with other disorders in Australia. However the rapid growth in amphetamine prescription and associated public concern have cast serious doubt over state government responses and recently forced the governments in Western Australia and South Australia to hold inquiries into ADHD treatment practices.

Given evidence that families only seek out medical explanations and treatments when they find home support systems and school responses inadequate, we note that such inquiries continued to find that inadequate government services resulted in needy families seeking both an advocacy tool (the ADHD label) and the only treatment readily available (psychostimulant medication).

The lack of government support for multi-modal ADHD treatment and an emphasis on individual deficit in funding have seen a greater burden shifting to over-stretched families. Failure to carry this emotional and financial burden results in more demands on other groups that spend significant amounts of time with our youth (i.e. special educators and classroom teachers). Although in some cases there may be problems originating from the inappropriate responses of individual teachers, the vast majority of responses by schools and special education teachers have been pragmatic and reasonable given the restraints placed upon them. However, inadequate human and financial resources severely restrict the capacity of schools and special educators to implement the full range of necessary services.

Recommendations

Labels such as ADHD exist in a cultural, political and economic nexus, and must not be assumed to be objective, value neutral or transparent. We warn against focusing effort on the inclusion of ADHD as a disability category, which in itself will not guarantee any additional interventions or assistance. Instead we urge more effort be devoted to understanding why it has become important to some sectors of the community that ADHD be included as a disability.

Legislative inconsistencies create definitional cracks through which children with ADHD may fall. These inconsistencies could be corrected by broadening eligibility criteria to any barrier to significant life activities (similar to the criteria of the American Section 504). This is not incompatible with an existing emphasis on the interaction of students with their learning environment (e.g. DECS, 1991). It would also enable the consideration of other important issues in the effective treatment of ADHD, such as self-esteem, social skills, peer relationships, and the influence of broader cultural contexts.

It is not the absence of ADHD as a disability category that prevents effective intervention. Helpful techniques are potentially available without reworking existing legislative and policy definitions. For example, assessment practices modeled on the functional or `goodness of fit' approaches have demonstrated effectiveness (Atkinson, Robinson, & Shute, 1997; Reid & Maag, 1998; Reid, Reason, Maag, Xu, & Prosser, 1998). Unfortunately some Australian special educators are unaware of these interventions, and others lack the resources to implement them effectively. Special educators must be provided with the skills and resources to reduce the gap between intervention theory and practice.

In addition, state governments should expand their current monitoring of psychostimulant use to cover the full implementation of multi-modal treatment. This would not only ensure international standards of treatment are met, but also provide information on areas for future research, professional training and resource allocation.

Conclusion

We find the inclusion of ADHD as a disability category to be of questionable utility. More effort should be devoted to understanding why it has become important to some sectors of the community that ADHD be so considered (an effort that would challenge discourses that claim an ADHD diagnosis to be the answer in itself). The growth of such discourses may see the social aspects of ADHD further ignored, creating a greater barrier to special educators meeting the needs of students. Instead, we call for a reconceptualisation of ADHD to highlight the role of cultural, economic and political influences on special education policy and practice in Australia.

Keywords

attention deficit    educational sociology   labelling (of persons)
 disorders
educational policy   hyperactivity           special education

References

Aleman, S. R. (1991). Special education for children with attention deficit disorder: Current issues (Congressional Research Service). Washington, DC: Library of Congress.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Vol. 4). Washington, DC: Author.

Atkinson, I., Robinson, J.A., & Shute, R. (1997). Between a rock and a hard place: An Australian perspective on education of children with ADHD. Educational and Child Psychology, 14, 21-30.

Atkinson, I. & Shute, R. (1999). Managing ADHD: Issues in developing multidisciplinary guidelines. Australian Journal of Guidance and Counselling, 9, 119-127.

Barkley, R. A. (1995). Taking charge Of ADHD. New York: Guilford Press.

Barkley, R. A. (1998). Attention-Deficit Hyperactivity Disorder: A handbook for diagnosis and treatment. New York: Guilford Press.

Becker, H. S. (1963). Outsiders: Studies in the sociology of deviance. New York: Free Press.

Becker, H. S. (Ed.). (1964). The other side. New York: Free Press.

Becker, H. S. (1973). Labeling theory reconsidered. In H.S. Becker (Ed.) Outsiders: Studies in the sociology of deviance (pp. 177-208). New York: Free Press.

British Psychological Society. (1996). Attention Deficit Hyperactivity Disorder (ADHD): A psychological response to an evolving concept. Leicester: Author.

Bussing, R., Schoenberg, N.E., Rogers, K.M., Zima, B.T., & Angus, S. (1998). Explanatory models of ADHD: Do they differ by ethnicity, child gender, or treatment status? Journal of Emotional and Behavioral Disorders, 6, 233-242.

Bussing, R., Schuhmann, E., Belin, T.R., Widawski, M., Perwien, A.R. (1998). Diagnostic utility of two commonly used ADHD screening measures among special education students. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 74-82.

Bussing, R., Zima, B.T., Perwein, A.R., Belin, T.R., & Widawski, M. (1998). Attention Deficit Hyperactivity Disorder, use of services and unmet need. American Journal of Public Health, 88, 880-886.

Comber, B., Green, B., Lingard, A., & Luke, A. (1997). Literacy debate and public education: A question of crisis. In A. Reid (Ed.), Going public: Education policy in Australia (pp. 18-36). Deakin, ACT: Australian Curriculum Studies Association.

Cooper, P. (1994). Attention Deficit Hyperactivity Disorder and the strange case of Vincent Van Gogh. Therapeutic Care and Education, 3, 86-95.

Cooper, P. & Ideus, K. (1995). Attention Deficit Hyperactivity Disorder: A trojan horse? Support for Learning, 10, 29-34.

Damico, J. S. & Augustine, L.E. (1995). Social considerations in the labeling of students as Attention Deficit Hyperactivity Disordered. Seminars in Speech and Language, 16, 259-74.

Department of Education and Children's Services (1991). Students with disabilities policy. Adelaide: DECS, Education Resource Unit.

Department of Education and Training. (1997). Talk, time, teamwork: Collaborative management of student with Attention Deficit Hyperactivity Disorder. Sydney: DET Publications.

Department of Education, Employment, Training & Youth Affairs. (1997). Commonwealth programmes for schools quadrennial administration guidelines 1997-2000. Canberra: DEETYA, Schools Division.

Department of Education, Training and Employment. (1999). Teaching and managing school students with poor attention, impulsivity or hyperactive behaviour. Adelaide: DETE, Programs Division.

Diller, L. H. (1998). Running on Ritalin: A physician reflects on children, society and performance in a pill. New York: Bantam Books.

DuPaul, G. J. & Stoner, G. (1994). ADHD in the schools: Assessment and intervention strategies. New York: Guilford Press.

Foucault, M. (1965). Madness and civilization. London: Random House.

Foucault, M. (1975). The birth of the clinic. New York: Vintage Books.

Foucault, M. (1977). Discipline and punish. New York: Vintage Books.

Gadow, K. D. (1993). Prevalence of drug therapy. In J. S. Werry & G. S. Aman (Eds.), Practitioners guide to psychoactive drugs (pp. 57-74). New York: Plenum Medical.

Goodson, I. & Dowbiggin, I. (1990). Docile bodies: Commonalities in the history of psychiatry and schooling. In S. J. Ball (Ed.), Foucault and education: Disciplines and knowledge (pp. 105-126). New York: Routledge.

Hazell, P. L., McDowell, M. J., & Walton, J.M. (1996). Management of children prescribed psychostimulant medication for attention deficit hyperactivity disorder in the Hunter region of NSW. Medical Journal of Australia, 165, 477-480.

Ideus, K. (1994). Cultural foundations of ADHD: A sociological analysis. Therapeutic Care and Education, 3,173-193.

Latham, P. S. & Latham, P.H. (1992). Attention Deficit Disorder and the law: A guide for advocates. Washington, DC: JKL Communications.

Maag, J. W. & Reid, R. (1994). Attention Deficit-Hyperactivity Disorder: A functional approach to assessment and treatment. Behavioral Disorders, 20, 5-23.

Macciomei, N. R. (1993). Advances in special education legislation and Attention Deficit Hyperactivity Disorders. In L.F. Koziol, C.E. Stout, & D.H. Ruben (Eds.), Handbook of childhood impulse disorders and ADHD: Theory and practice (pp. 108-120). Springfield, MA: Charles C. Thomas.

Miller, D. & Branson, J. (1989). Beyond integration policy: The deconstruction of disability. In L. Barton (Ed.), Integration: Myth or reality? (pp. 144-166). London: Falmer Press.

National Health and Medical Research Council. (1997). Attention Deficit Hyperactivity Disorder (ADHD). Canberra: Commonwealth Government Printers.

Oliver, M. (1990). The politics of disablement: A sociological approach. New York: St. Martin's Press.

Prosser, B. (2000). Behaviour management or management behaviour: A sociological study of Attention Deficit Hypearctivity Disorder (ADHD) in Australian and US secondary schools, Unpublished doctoral thesis, Flinders University of South Australia.

Prosser, B. & Reid, R. (1999). Psychostimulant use for children with Attention Deficit Hyperactivity Disorder in Australia. Journal of Emotional and Behavioral Disorders, 7, 110-117.

Reid, R. & Katsiyannis, A. (1995). Attention-Deficit/Hyperactivity Disorder and Section 504. Remedial and Special Education, 16, 44-52.

Reid, R. & Maag, J. W. (1998). Functional assessment: Developing classroom-based accommodations and interventions for children with ADHD. Reading and Writing Quarterly, 14, 9-42.

Reid, R., Maag, J. W., & Vasa, S.F. (1994). Attention Deficit Hyperactivity as a disability category: A critique. Exceptional Children, 60, 198-214.

Reid, R., Maag, J. W., Vasa, S.F., & Wright, G. (1994). Who are the children with Attention Deficit-Hyperactivity Disorder? A school based survey. Journal of Special Education, 28, 117-132.

Reid, R., Reason, R., Maag, J. W., Prosser, B., & Xu, C. (1998). ADHD: A perspective on perspectives. Educational and Child Psychology, 15, 56-67.

Reid, R., Vasa, S. F., Maag, J. W., & Wright, G. (1994). An analysis of teachers' perceptions of Attention Deficit-Hyperactivity Disorder. Journal of Research and Development in Education, 27, 195-202.

Smyth, J. & Hattam, R. (1998). Schooling for a fair go: (re)making the social fabric. In J. Smyth, R. Hattam, & M. Lawson (Eds.), Schooling for a fair go (pp. 1-14). Sydney: Federation Press.

Standing Committee on Constitutional Affairs. (1999). Report in relation to a petition regarding Attention Deficit Hyperactivity Disorder. Perth: Western Australian Parliament.

Tally-Ongan, A. (1997). Contextual variables in ADHD. Paper presented at the 5th Conference on Australian ADHD Research in Early Childhood Education, Canberra, 26 January 1997.

Thomson, P. (1997). Back on the borderline: The marginalisation of equity in federal schools policy. Educational Leader, 9, 1-9.

Turnbull, H. R. (1994). Free appropriate public education: The law and children with disabilities. Denver, CO: Love Publishing.

Valentine, J., Zubrick S., & Sly, P., (1996). National trends in the use of stimulant medication for Attention Deficit Hyperactivity Disorder. Journal of Paediatric Child Health, 32, 223-227.

Wakefield, J. C. (1992). The concept of mental disorder: On the boundary between biological facts and social values. American Psychologist, 47, 373-388.

Whalen, C. K. & Henker, B. (1996). Attention deficit/hyperactivity disorders. In T. H. Ollendick & M. Hersen (Eds.), Handbook of child psychopathology (3rd ed.). New York: Plenum Press.

World Health Organization. (1993). Classification of mental and behavioural disorders: Diagnostic criteria for research. In World Health Organization, International Classification of Diseases (10th ed.). Geneva: WHO Office of Publications.

Brenton Prosser completed his doctoral study of ADHD and education policy within the Flinders Institute for the Study of Teaching, Bedford Park, South Australia 5042. Email: [e-mail]

Robert Reid is an Associate Professor within the Special Education and Communication Disorders Faculty of the University of Nebraska, Lincoln, Nebraska 68583-0732. Email: [e-mail]

Rosalyn Shute is an Associate Professor of Psychology at the Flinders University of South Australia, Bedford Park, South Australia 5042. Email: [e-mail]

Ivan Atkinson is a registered psychologist and head of Counselling at Tabor College, Millswood, South Australia 5034. Email: [e-mail]